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Your Full Name
(Required)
First
Last
Year Started with PEP
You marital status?
Single
Married
Common Law
Divorced
Widowed
Do you live in
Transitional home
Living with relative(s)
Rent an apartment/condo
Rent a house
Own a house
Are you currently employed?
Yes
No
How long have you been with your current employer?
Less than 1 month
2 to 3 months
4 to 6 months
7 to 12 months
more than 1 year
How long have you been unemployed?
< 1 month
1 to 3 months
4 to 6 months
7 to 12 months
More than 1 year
What is your current hourly rate (what the hourly rate equals as an annual salary)?
$10.00 or less (less than $21,000)
$10.01 to $15.00 (between $21,001 and $31,000)
$15.01 to $20.00 (between $31,001 and $42,000)
$20.01 to $25.00 (between $42,001 and $52,000)
25.01 or more (more than $52,000)
Have you started a business since your release?
Yes
No
You business information
Industry
What year did you start your business?
Is your business active?
Yes
No
Business Revenue Last Year (2024)
$0 - $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $999,999
More than $1,000,000
Business Revenue Projected for This Year (2025)
$0 - $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $999,999
More than $1,000,000
Are you operating your business full or part-time?
Full-time
Part-time
How many employees do you have, including yourself?
1
2 to 3
4 to 5
More than 5
Is your business profitable?
No - Struggling to find customers
No - Nearly breaking even
Yes - Small profit
Yes - Doing well
Select all of the following reasons you closed your business.
Lack of funding
Lack of passion
Not making enough to substain business and family
License(s)
Insurance, Legal, Accounting, Taxes issue
Unable to make transition from full-time employment to full-time business owner
Bad business concept
Other
Choose as many options as you'd like.
Select all or any that apply to you
Want to go to prison to share my story with my PEP brothers
Keep me informed with all PEP news
Invite me to outside events
Want to participate in the 2026 Barded Wire to Business (Must have an active business)
Help with my Business Idea
Choose as many options as you'd like.
Which parts of the program are userful to you?
Effective Leadership (Leadership Academy)
Men's Life
PEP 10 Driving Values
ToastMasters
Entrepreneurship Teaching
Business Plan Writing
Personal Finance
Personality Indicator (Enneagram/MBTI)
Reentry Services
Choose as many options as you'd like.
Phone
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Email
Comments
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